Editor's Choice
M-A | Comparison of mental health symptoms before and during the covid-19 pandemic
21 Mar, 2023 | 13:40h | UTCEditorial: Mental health and the covid-19 pandemic – The BMJ
News Release: Study suggests little deterioration in mental health linked to the pandemic – BMJ Newsroom
Commentaries:
A patient’s perspective on mental health and the pandemic – The BMJ
World’s most comprehensive study on COVID-19 mental health – McGill University
RCT | Closed-loop insulin delivery system enhances blood sugar control in young children with type 1 diabetes
20 Mar, 2023 | 13:54h | UTCSummary: The study enrolled 102 young children between ages 2 and 5, randomized in a 2:1 ratio to either a closed-loop control system of insulin delivery (“artificial pancreas”) or a standard care comparison group. During the 13 weeks of study follow-up, participants in the artificial pancreas group spent 12% more time within their target blood glucose range compared to the standard care group.
The closed-loop group experienced two cases of severe hypoglycemia, while the standard-care group had one case. In the closed-loop group, one case of diabetic ketoacidosis occurred due to a problem with the insulin pump.
Article: Trial of Hybrid Closed-Loop Control in Young Children with Type 1 Diabetes – New England Journal of Medicine (link to abstract – $ for full-text)
News Releases:
Commentary on Twitter
In children 2 to younger than 6 years of age with type 1 diabetes, a closed-loop control system was associated with a greater percentage of time in the target glycemic range than standard care. https://t.co/rAOLXRNuub#pediatrics #T1D pic.twitter.com/Nzwl3aFr1w
— NEJM (@NEJM) March 17, 2023
Cohort Study | Early childhood respiratory infections linked to increased risk of premature respiratory disease mortality in adulthood
20 Mar, 2023 | 13:52h | UTCSummary: The study aimed to determine the link between lower respiratory tract infections (LRTIs) in early childhood and premature adult death from respiratory disease. The study used data from a nationally representative cohort recruited at birth in Great Britain in 1946 and followed participants across eight decades.
After adjusting for multiple markers of childhood social disadvantage and adult smoking, the study found that individuals who had an LRTI by age 2 years were 93% more likely to die prematurely from respiratory disease as adults than those who did not have early childhood LRTI, accounting for one-fifth of these deaths and an estimated 179,188 excess deaths across England and Wales between 1972 and 2019.
However, it is important to note that this observational study cannot establish causality, but rather suggests that early childhood LRTI is a marker of increased risk of respiratory-cause deaths later in life.
News Release: Respiratory disease in early childhood linked to higher risk of death for adults – Imperial College London
Commentaries:
Childhood bronchitis, pneumonia tied to premature respiratory death in adults – CIDRAP
Early childhood lower respiratory tract infection: a key determinant of premature adult respiratory mortality – The Lancet (free registration required)
Commentary from the author on Twitter (thread – click for more)
1/ Great to see the interest in our @TheLancet paper linking lower respiratory tract infections in early childhood to the risk of premature adult death from respiratory disease across Great Britain.
A🧵exploring our study (1/21)
Full paper link below:https://t.co/LlGQJC1wAP
— James P Allinson (@JPAllinson) March 11, 2023
COVID-19 pandemic measures may have caused reduced cognitive abilities among German students, study shows
20 Mar, 2023 | 13:50h | UTCSummary: This study investigated the impact of the COVID-19 pandemic on the cognitive abilities of secondary school students in Germany. The study compared the intelligence test performance of 424 students in Grades 7 to 9, tested after the first six months of the pandemic, to the results of two highly comparable student samples tested in 2002 and 2012.
The study found that the 2020 sample had substantially lower intelligence test scores than both the 2002 and 2012 samples. The study also retested the 2020 sample after another full school year of COVID-19-affected schooling in 2021 and found no signs of catching up to previous cohorts or further declines in cognitive performance.
It can be inferred from the article that the lower intelligence test scores of the 2020 sample may have been caused by the prolonged disruption of regular schooling due to the COVID-19 pandemic, including lockdowns and school closures.
The study highlights the potential negative impact of the COVID-19 pandemic on the cognitive abilities of secondary school students and suggests that these consequences should be taken into account when conducting intelligence assessments in the post-pandemic era. It also recommends that appropriate compensatory measures be implemented to address any learning loss or cognitive deficits that may have resulted from the disruption of regular schooling during the pandemic.
EULAR recommendations for the management of ANCA-associated vasculitis
20 Mar, 2023 | 13:47h | UTC
Review | Diseases affecting middle-aged and elderly individuals with trisomy 21
20 Mar, 2023 | 13:44h | UTC
Opinion | Irreconcilable differences: the divorce between response rates, progression-free survival, and overall survival
20 Mar, 2023 | 13:45h | UTC
COVID-19-associated mucormycosis | A systematic review and meta-analysis of 958 cases
20 Mar, 2023 | 13:43h | UTC
AHA Scientific Statement | Evaluation and management of pulmonary hypertension in noncardiac surgery
17 Mar, 2023 | 13:12h | UTCTop Things to Know: Evaluation and Management of Pulmonary HTN in Non-Cardiac Surgery – American Heart Association
Cohort Study | COVID-19 outpatients mostly at low risk for VTE, but age, being male, and obesity are risk factors
17 Mar, 2023 | 13:11h | UTCSummary: The article discusses a cohort study that aimed to assess the risk of venous thromboembolism (VTE) among outpatients with COVID-19 and identify independent predictors of VTE.
The study used data from two integrated healthcare delivery systems in California and included 398.530 nonhospitalized adults aged 18 years or older with COVID-19 diagnosed between January 1, 2020, and January 31, 2021, with follow-up through February 28, 2021.
The results showed that the overall risk of VTE among outpatients with COVID-19 is low, but higher in the first 30 days after diagnosis. Factors associated with a higher risk of VTE in COVID-19 outpatients included:
- Age 55 years or older.
- Being male.
- history of VTE or thrombophilia.
- Body mass index greater than or equal to 30.0.
The study’s results could inform future randomized trials to explore targeted VTE preventive strategies and more intensive short-term surveillance for patients with COVID-19 who are at a higher risk of developing VTE.
Commentary: Venous blood clots rare among COVID-19 outpatients, study finds – CIDRAP
Commentary on Twitter
The rate of VTE was low in outpatients with #COVID19 in the first 30 days, and even lower >30 days. Factors associated with a higher risk of VTE in included age ≥55, male, prior VTE/thrombophilia, and BMI ≥30. https://t.co/3hwfDW88k4
— JAMA Network Open (@JAMANetworkOpen) March 13, 2023
FDA issues new information on cases of squamous cell carcinoma and lymphomas around breast implants
16 Mar, 2023 | 13:28h | UTCSummary: The US Food and Drug Administration (FDA) has provided an update on reports of squamous cell carcinoma (SCC) in the scar tissue (capsule) that forms around breast implants. The FDA is aware of 19 cases of SCC in the capsule around the breast implant from published literature, including 3 reports of deaths from the disease.
While the FDA continues to believe that occurrences of SCC in the capsule around the breast implant may be rare, the cause, incidence, and risk factors remain unknown. Health care providers and people who have or are considering breast implants should be aware that cases of SCC and various lymphomas in the capsule around the breast implant have been reported to the FDA and in the literature.
The FDA continues to ask health care providers and people with breast implants to report cases of SCC, lymphomas, or any other cancers around breast implants.
FDA Safety Communication: Reports of Squamous Cell Carcinoma (SCC) in the Capsule Around Breast Implants – FDA Safety Communication – U.S. Food & Drug Administration
Related:
FDA Report: 660 Cases of Breast Implant-Associated Anaplastic Large Cell Lymphoma
Study: Long-term Outcomes of Silicone Breast Implants
RCT | Pre-hospital rule-out of NSTE-ACS by ambulance paramedics with point-of-care troponin is feasible and cost-saving
16 Mar, 2023 | 13:27h | UTCSummary: Using a point-of-care (POC) troponin measurement, this randomized trial in the Netherlands assessed the safety and healthcare costs of a pre-hospital rule-out strategy for patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
The study included only patients considered at low risk with a HEAR (History, ECG, Age, Risk factors) score ≤3. A total of 863 low-risk participants were randomized to direct transfer to the ED or a pre-hospital rule-out strategy with POC troponin measurement.
The trial found that pre-hospital rule-out of NSTE-ACS in low-risk patients using a single POC troponin measurement is feasible, significantly reduces healthcare costs, and is associated with a low incidence of major adverse cardiac events.
The HEAR score, combined with a POC troponin measurement by ambulance paramedics, accurately identifies low-risk patients for whom ED evaluation is unnecessary. Implementing this pre-hospital rule-out strategy in low-risk patients could significantly reduce healthcare costs through more efficient use of ambulance services and fewer ED visits. It is worth noting, however, that further studies in other localities are necessary before the widespread use of this strategy can be implemented.
Commentaries:
JC: Can we rule out ACS by a single prehospital troponin measurement? – St. Emyln’s
Rule-Out of NSTE-ACS by a Prehospital Troponin Measurement – American College of Cardiology
RCT | Preliminary study suggests early methylene blue administration reduces vasopressor duration in septic shock patients
16 Mar, 2023 | 13:25h | UTCSummary: The study aimed to evaluate the efficacy and safety of early adjunctive methylene blue (MB) administration in patients with septic shock. In this single-center randomized controlled trial, 91 patients were randomly assigned to receive MB or placebo, with the primary outcome being the time to vasopressor discontinuation at 28 days.
The study found that the MB group had a significantly shorter time to vasopressor discontinuation, one more day of vasopressor-free days at day 28, a shorter length of stay in the ICU and hospital, and no serious adverse effects related to MB administration.
However, the study was limited by its small sample size and single-center design. Therefore, larger multicenter randomized clinical trials are needed to confirm the potential benefit of MB as an early adjunctive therapy in patients with septic shock.
RCT | Patient-reported outcomes 12 years after different treatments for localized prostate cancer
15 Mar, 2023 | 15:24h | UTCSummary: The article reports on a study that evaluated patient-reported outcomes of 1,643 participants in the ProtecT trial over a period of 7 to 12 years to assess the long-term functional and quality-of-life impacts of prostatectomy, radiotherapy with neoadjuvant androgen deprivation, and active monitoring for localized prostate cancer detected by PSA screening.
The study found that generic quality-of-life scores were similar among the randomized groups over 7 to 12 years. However, although the prostatectomy group had a lower incidence of nocturia, they showed a higher incidence of urinary incontinence and sexual dysfunction compared to the radiotherapy and active monitoring groups. The radiotherapy group had a higher incidence of fecal leakage compared to the other groups.
The study provides evidence that helps patients and their clinicians assess the trade-offs between treatment harms and benefits and make better-informed treatment decisions.
Article: Patient-Reported Outcomes 12 Years after Localized Prostate Cancer Treatment – NEJM Evidence
Original Study: RCT | Localized prostate cancer treatment options have similar 15-year survival outcomes
SR | Therapeutics for treating mpox in humans – still no evidence from randomized trials
15 Mar, 2023 | 15:20h | UTCTherapeutics for treating mpox in humans – Cochrane Library
Summary: Therapeutics for treating mpox – Cochrane Library
Updated recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission
15 Mar, 2023 | 15:22h | UTC
Review | Diagnosis and management of endometriosis
15 Mar, 2023 | 15:19h | UTCDiagnosis and management of endometriosis – Canadian Medical Association Journal
Review | Heart failure with preserved ejection fraction
15 Mar, 2023 | 15:18h | UTCHeart Failure With Preserved Ejection Fraction: A Review – JAMA (free for a limited period)
Author Interview: Diagnosis and Treatment of Heart Failure with Preserved Ejection Fraction – JAMA
RCT | Intrapartum azithromycin fails to reduce neonatal sepsis and death
14 Mar, 2023 | 14:00h | UTCSummary: This randomized controlled trial aimed to evaluate the effectiveness of administering azithromycin during labor to reduce neonatal sepsis and mortality. The randomized trial involved 11,983 birthing parents and their infants in West Africa.
The study found no significant difference in the incidence of neonatal sepsis or mortality between the azithromycin and placebo groups. On the other hand, the rate of non-invasive infections, including skin infections in newborns, and mastitis and puerperal fever in parents, was lower in the azithromycin group in the following four weeks.
The authors concluded that these results do not support the routine introduction of oral intrapartum azithromycin to reduce neonatal sepsis or mortality. However, it is important to notice that a recent large study published in the New England Journal of Medicine showed conflicting results.
Article: Effect of Intrapartum Azithromycin vs Placebo on Neonatal Sepsis and Death: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentaries:
Azithromycin during labor doesn’t reduce sepsis, mortality in newborns – CIDRAP
Effect of antibiotics during pregnancy on neonatal sepsis and mortality – MedicalResearch.com
Related study with conflicting results: Azithromycin to Prevent Sepsis or Death in Women Planning a Vaginal Birth – New England Journal of Medicine (link to abstract – $ for full-text)
News Release: Single-dose antibiotic prevents maternal sepsis and death – NIH News
Commentaries:
In large study, a single antibiotic dose slashed rate of sepsis in childbirth – STAT
Dose of azithromycin found to cut risk of maternal death, sepsis in childbirth – CIDRAP
Commentary on Twitter
Study results do not support routine introduction of oral intrapartum azithromycin to reduce neonatal sepsis or mortality. https://t.co/yDpg1CCGa2 pic.twitter.com/5Oc4HqZ4sX
— JAMA (@JAMA_current) March 7, 2023
AHA Scientific Statement | Atrial fibrillation occurring during acute hospitalization
14 Mar, 2023 | 14:04h | UTC
RCT | Sotatercept improves exercise capacity in patients with pulmonary arterial hypertension
14 Mar, 2023 | 14:02h | UTCSummary: This multicenter, double-blind randomized trial involved 323 adults with Pulmonary Arterial Hypertension (PAH) who were randomized to receive either subcutaneous sotatercept or placebo every three weeks for 24 weeks.
The primary endpoint was the change from baseline in the 6-minute walk distance. Sotatercept demonstrated a greater improvement in exercise capacity compared to placebo and improved secondary endpoints, including pulmonary vascular resistance and WHO functional class.
Adverse events were more common in the sotatercept group and included epistaxis, dizziness, telangiectasia, increased hemoglobin levels, thrombocytopenia, and increased blood pressure.
Article: Phase 3 Trial of Sotatercept for Treatment of Pulmonary Arterial Hypertension – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries:
STELLAR, ‘Impressive’ Results With Novel Drug Sotatercept in PAH – TCTMD
Scanxiety among adults with cancer: a scoping review to guide research and interventions
14 Mar, 2023 | 13:55h | UTCSummary: The article presents a scoping review of existing literature on scanxiety, which refers to the anxiety and distress experienced by cancer patients before and after medical imaging scans. The authors identified and synthesized findings from 36 articles on scanxiety among adults diagnosed with current or prior cancer.
The authors observed that scanxiety is a prevalent issue throughout the cancer continuum and may be linked to various factors related to the procedure itself or the uncertainty surrounding the possible outcomes of the scans.
The waiting period between the scan procedure and receipt of the results was described as particularly stressful, with participants reporting feeling overwhelmed by negative thoughts and fears about the potential outcomes of the scan. Some participants even found it difficult to focus on daily activities or responsibilities during this time.
The authors suggest that implementing supportive measures during scan experiences, including examining the waiting period between scans and scan results, could enhance the well-being for individuals with cancer who are going through different stages of treatment.
Article: Scanxiety among Adults with Cancer: A Scoping Review to Guide Research and Interventions – Cancers
SR | Environmental interventions can reduce falls in high-risk older adults
14 Mar, 2023 | 13:58h | UTCSummary: Falls and fall-related injuries are common among older adults and can have serious consequences, such as restricting activity or institutionalization. The Cochrane review aimed to assess the effects of environmental interventions, such as fall-hazard reduction, assistive technology, home modifications, and education, on preventing falls in older adults living in the community.
The review included 22 randomized controlled trials from 10 countries involving 8,463 community-residing older people. The study found that home fall-hazard interventions, which involve evaluating potential fall hazards and implementing safety adaptations or behavioral strategies, can reduce the rate of falls by 26% and the number of people who experience one or more falls by 11% in people at a higher risk of falling.
On the other hand, the study did not find any evidence of a decrease in the rate of falls when the interventions were not targeted toward individuals at higher risk. Additionally, the study suggests that these interventions are unlikely to have a significant impact on health-related quality of life, and there may be little or no difference in the risk of fall-related fractures, hospitalizations due to falls, or the rate of falls that require medical attention.
Summary: Reducing fall hazards within the environment – Cochrane Library
Commentary: Preventing falls in older people: new evidence on what helps – Evidently Cochrane
Video | Tutorial explores ways of analyzing data from RCTs, including intention-to-treat, per-protocol, and as-treated analyses
14 Mar, 2023 | 13:53h | UTCGood Intentions to Treat – NEJM Evidence
M-A | Ionizing radiation and cardiovascular disease
14 Mar, 2023 | 13:49h | UTCIonising radiation and cardiovascular disease: systematic review and meta-analysis – The BMJ
News Release: Low dose radiation linked to increased lifetime risk of heart disease – BMJ Newsroom